Provider First Line Business Practice Location Address:
404 N BAUGHMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ULYSSES
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67880-2058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-356-3198
Provider Business Practice Location Address Fax Number:
620-356-3101
Provider Enumeration Date:
11/28/2022